Organization · NPI-2
Speckled Frog Pediatric Therapy, INC.
Occupational Therapist · Brawley, CA
NPI number1922876218
StatusActive
Last updated in NPPESDec 15, 2023
Details
- NPI
- 1922876218
- Entity type
- Organization (NPI-2)
- Legal business name
- Speckled Frog Pediatric Therapy, INC.
- Organization subpart
- No
- Enumeration date
- Dec 15, 2023
- Certification date
- Dec 15, 2023
- Last updated
- Dec 15, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225X00000X | Occupational Therapist | – | – | Yes |
| 261Q00000X | Clinic/Center | – | – |
Practice location
643 Main StBrawley, CA 92227-2547
Phone 760-235-9047
Mailing address
11003 Exposition BlvdLos Angeles, CA 90064-3139
Phone 760-235-9047
Authorized official
Sarah Elizabeth O'Brien
President
7602359047
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